Mindful Parenting in Mental Health Care

ORIGINAL PAPER

Mindful Parenting in Mental Health Care

Susan M. Bögels & Annukka Lehtonen & Kathleen Restifo

Published online: 25 May 2010# The Author(s) 2010. This article is published with open access at Springerlink.com

Abstract Mindfulness is a form of meditation based on theBuddhist tradition, which has been used over the last twodecades to successfully treat a multitude of mental healthproblems. Bringing mindfulness into parenting (“mindfulparenting”) is one of the applications of mindfulness.Mindful parenting interventions are increasingly being usedto help prevent and treat mental disorders in children,parenting problems, and prevent intergenerational transmis-sion of mental disorders from parents to children. However,to date, few studies have examined the hypothesizedmechanisms of change brought about by mindful parenting.We discuss six possible mechanisms through whichmindful parenting may bring about change in parent–childinteractions in the context of child and parent mental healthproblems. These mechanisms are hypothesized to bemediated by the effects of mindfulness on parental attentionby: (1) reducing parental stress and resulting parentalreactivity; (2) reducing parental preoccupation resultingfrom parental and/or child psychopathology; (3) improvingparental executive functioning in impulsive parents; (4)breaking the cycle of intergenerational transmission of

dysfunctional parenting schemas and habits; (5) increasingself-nourishing attention; and (6) improving marital func-tioning and co-parenting. We review research that hasapplied mindful parenting in mental health settings, with afocus on evidence for these six mechanisms. Finally, wediscuss directions for future research into mindful parentingand the crucial questions that this research should strive toanswer.

Keywords Mindfulness . Parenting .

Child mental disorder . Parent mental disorder . Attention .

Mindful parenting

Introduction

Mindfulness is a form of meditation based on the Buddhisttradition. Over the last two decades, mindfulness-basedinterventions have been used to successfully treat amultitude of mental health problems. Bringing mindfulnessinto parenting (“mindful parenting”) is one of the newerapplications of mindfulness in mental health contexts.Mindful parenting has been defined by Kabat-Zinn andKabat-Zinn (1997) as: “paying attention to your child andyour parenting in a particular way: intentionally, hereand now, and non-judgementally”. Several papers haveaddressed the role of mindful parenting in mental healthproblem prevention and treatment contexts on a theoretical,descriptive practical, and/or empirical outcome level (e.g.,Altmaier and Maloney 2007; Bögels et al. 2008; Dumas2005; Duncan et al. 2009; Sawyer 2007; Singh et al. 2007;Wahler et al. 2008). However, less attention has been paidto the underlying mechanisms of change, particularly in thecontext of mental health problems in parents and/orchildren. Our goal is to review the mindful parenting

S. M. Bögels (*)Research Institute of Child Development and Education,University of Amsterdam,Nieuwe Prinsengracht 130,1018 VZ, Amsterdam, The Netherlandse-mail: [email protected]

A. LehtonenDepartment of Psychiatry, University of Oxford,Oxford, UK

K. RestifoDepartment of Clinical Psychological Science,Maastricht University,Maastricht, The Netherlands

Mindfulness (2010) 1:107–120DOI 10.1007/s12671-010-0014-5

literature from the perspective of issues involved in whymindful parenting may work in the context of child andparent mental health problems. Before discussing theseissues, we first review research into the effects of mindful-ness on attention, in general. And before that, we will firstshortly address the effects of mindfulness-based treatmentapproaches to adult mental health problems. We concludethe paper with directions of research into the effectivenessof mindful parenting in general and into the issuesinvolved in change through mindful parenting in particular.

How Has Mindfulness Been Applied in Therapies?

Kabat-Zinn (1990) developed the mindfulness-based stressreduction (MBSR) program for trying to help chronically illpeople to cope with their illness. MBSR has been helpfulfor a variety of physical and psychological conditions.Grossman et al. (2004) did a meta-analysis on the (mental)health benefits of MBSR programs and consistently foundrespectable effect sizes for MBSR interventions. This wasalso the case for studies that included control treatments,which would suggest a benefit specific for mindfulnesstraining. Similar findings were reported by Baer (2003).

Mindfulness meditation is the basis of mindfulness-based cognitive therapy (MBCT), a treatment approachdeveloped specifically for depressed patients (Segal et al.2002). MBCT targets the patterns of thinking activated bydysphoria: the association between low mood and negative,repetitive thinking that is characteristic of major depression.This kind of thinking is still assumed to be typical forpatients recovered from depression, who can be vulnerableto subsequent periods of low mood, as this may re-activatethe negative cognitions. The aim of the intervention is toenable participants to decenter or take distance from theirnegative thinking and therefore interrupt the cycle ofnegative, repetitive thoughts before they escalate into full-blown depressive episode again.

Several studies have demonstrated the effectiveness ofthe MBCT program in decreasing the likelihood of anotherdepressive episode among patients with more than threeepisodes of depression (e.g., Ma and Teasdale 2004;Teasdale et al. 2001). Note that ruminative thinking hasalso been found characteristic for many other mentaldisorders, such as anxiety and eating disorders, and thus,mindfulness training could be beneficial for those disordersas well. In line, mindfulness-based approaches have beenfound effective in mental disorders in which rumination is acentral feature, such as generalized anxiety disorder(Roemer et al. 2008), social anxiety disorder (Bögels etal. 2006), and eating disorders (Kristeller et al. 2006). Inaddition to the MBSR and the MBCT, other empiricallysupported intervention programs have included mindfulness

training as one of the components involved [dialecticalbehavior therapy, Linehan (1993) and acceptance andcommitment therapy, Hayes et al. (1999)].

Attention and Mindfulness

Before understanding possible working mechanisms ofmindfulness for improving parenting in mental healthcontexts, we focus on understanding change through mind-fulness in general. Attentional processes may be one of thekey mechanisms underlying change in mindfulness. Bishop(2002) pointed out that the concepts involved in mindful-ness—being present in the moment, focussing on the realityand accepting it for what it is—all involve different aspectsof attention. This is consistent with the argument that, ingeneral, meditation modifies attention, as highlighted by forexample Valentine and Sweet (1999), Brown and Ryan(2003) and Sethi (1989), and by Cahn and Polich (2006) inthe context of different brain imaging studies. However,despite the general connection that has been drawn betweenattention and meditation, there has not been much researchinvestigating the specific ways in which mindfulnessmeditation affects attention. It is not possible to provide acomprehensive overview of all the available studies in thispaper, but we will mention a few studies that demonstrate therole of attention in mindfulness.

Mindfulness has been shown to improve executiveattention in general. Using the Attention Network Test,which requires participants to respond to an arrow target,flanked by distractors that point either to the same ordifferent direction as the arrow, Jha et al. (2007) foundimprovements in participants’ performance depending ontheir meditation experience. The results suggested that, tobegin with at baseline, participants with prior experience inmeditation had better conflict monitoring skills (ability toprioritize between conflicting responses and tasks) thanparticipants with no experience and that taking part in theMBSR course improved orienting skills. Jha et al. (2007)argued that previous or newly gained meditation experienceimproves voluntary top-down attention control. Tang et al.(2007) had an experimental group do 5 days of integrativebody–mind training (including mindfulness meditation asone component) while a control group was assigned torelaxation training. Again, the Attention Network Test wasused to measure attention abilities before and after training.Like Jha et al. (2007), Tang et al. found that the grouptrained in meditation did better in conflict monitoring aftertraining, while there was no effect on the control group whoreceived relaxation training. However, the training had noeffect on orienting or alerting skills, and Tang et al. (2007)suggested that short-term meditation practice improvesexecutive attention in particular.

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The effect of mindfulness training on participants’performance in attention interference tasks has also beenexamined. Ortner et al. (2007) tested participants whodiffered in the length of their meditation experience andfound that the longer a participant had been meditating, theless emotional interference they showed. The task requiredparticipants to categorize tones while being presented withneutral, pleasant, or unpleasant pictures. The effects ofmeditation experience emerged both for pleasant andunpleasant pictures. Ortner et al. (2007) further showedthat when meditation-naïve participants were assigned tomindfulness meditation, relaxation meditation training, orwaitlist control, after 7-week training, only the mindfulnessmeditation group showed a reduction in emotional interfer-ence, that is, they were quicker to disengage their attentionfrom emotional stimuli. Furthermore, the mindfulnessgroup was the only one to report decreased intensity offeelings after seeing the unpleasant pictures. Wenk-Sormaz(2005) used the Stroop paradigm and showed that partic-ipants in mindfulness sitting meditation group showed lessinterference in the Stroop task than participants in thecontrol group. Finally, Valentine and Sweet (1999) foundthat both mindfulness and concentrative meditators didbetter on a sustained attention task than controls, andmindfulness meditators were better than the other groupswhen the stimuli were unexpected, suggesting that theywere less susceptible to the finding that focussed attentionis impaired with unexpected stimuli.

The studies discussed above suggest that attention is oneof the cognitive processes influenced by mindfulness. Inparticular, the ability to disengage from unexpected andemotional stimuli and attention conflict monitoring improveas a result of meditation practice. It is important to note thatthis research is still very much at the beginning stage. Theresults are often inconclusive because the tasks used tomeasure attention, the interventions introduced as mindful-ness practices, and the groups tested vary from one study toanother. The studies have also thus far largely failed to dolonger-term follow-up, so it is impossible to know whetherthe effects on attention are long-lasting or not. Consequent-ly, it is not possible to determine at this point in time howexactly mindfulness affects attention.

Why Try Mindfulness for Improving Parenting?

When considering mindfulness and how it might suitaddressing issues central in parenting, in the context ofparent and child mental health problems, there are severalissues that need to be taken into account. They all involvethe role of attention. We hypothesize that mindfulness-based parenting interventions may exert their effects bytargeting six domains: (1) parental stress; (2) parental

preoccupation resulting from parental and/or child psycho-pathology; (3) parental executive functioning; (4) repeatingdysfunctional own upbringing schemes and habits; (5)self-nourishing attention; and (6) marital functioning andco-parenting. Improvements in these six domains maypositively affect the parent–child relationship and parent-ing skills.

Parenting Stress

The first hypothesis to be explored is that mindfulnesstraining reduces parental stress, and thereby improvesparenting. Parenting stress has been found to strongly affectparenting skills: under stress, parents become more reject-ing, controlling, and reactive, and less warm towards theirchildren (e.g., Belsky 1984; Webster-Stratton 1990). Toillustrate, Crnic et al. (2005) found that, in a longitudinalstudy of 125 typically developing children, cumulativemajor life event stress and cumulative parenting dailyhassles independently predicted less maternal positivity ininteraction with their 5-year-old child. Cumulative stressresulting from parenting daily hassles (but not major lifeevent stress) also predicted less dyadic parent–childpleasure. One explanation for the effect of parental stresson parenting was suggested by Siegel and Hartzell (2004).In stressful parenting situations (e.g., a child refusing to goto school and throwing him/herself on the ground), parentsmay fall back into a fight, flight, or freeze response whichis activated under threat—the basic survival response. Thisfast response is a short route in the brain, located in thebrainstem. The brainstem helps regulate aspects of alertnessand the bodily functions such as breathing and heart rate.The brainstem is also responsible for our fight–flight–freezeresponse, combined with the limbic area (Siegel 2009).This short route in the brain does not involve the prefrontalcortex, which is important for paying attention. A survivalresponse such as fighting is functional in situation of realdanger, as it is fast (e.g., parent grasping the child’s armwith force when the child is crossing a road full of traffic)but is ineffectual and potentially destructive for the parent–child relationship in cases where there is no real orimmediate danger. A flight or freeze response may be seenin depressed or anxious parents, who withdraw from thechild under stress. Parents who suffer from mentaldisorders, or who have children with mental disorders, arelikely to be exposed to more stress (e.g., Baker-Ericzen etal. 2005).

It is interesting to note that parenting stress not onlynegatively affects parenting, but also negatively affects theperceived marital quality (Lavee et al. 1996). As maritalquality, in turn, negatively affects parenting (discussedbelow in the section Marital Functioning and Co-parenting),there appears to be a direct and indirect way in which

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parental stress negatively affects parenting. Mindfulnesstraining directly intervenes in parental stress and, as such,may be an alternative way of intervening in parentingskills, in addition to or as an alternative for parent trainingprograms.

Parental Preoccupation

The second hypothesis to be explored is that mindfulnessimproves parenting by reducing parental preoccupationand/or negative bias. These have been widely documentedin the context of postnatal depression, and an importantfactor involved in this process seems to be the way inwhich depression affects the parent’s (in most existingstudies, the mother’s) sensitivity and, consequently, parent–child interaction (Goodman and Gotlib 2002; Murray et al.1993, 1996; Restifo and Bögels 2009; Stein et al. 1991).Stein et al. (2009) suggested that attention plays animportant part in this. They argued that because mothers’attention is taken up by their repetitive, negative,preoccupied thinking, which is characteristic to depression(Nolen-Hoeksema 1991, 2000), they have less attention toallocate to their child during interaction. Consequently, themother is more likely to miss the child’s cues, and theinteraction is thus less sensitive and synchronized thaninteraction between well mothers and their children. Further-more, Sawyer (2007) described mindfulness as a necessaryprerequisite for the affective attunement that occurs withinthe intersubjective relatedness of mother and infant thatoccurs around the infant’s seventh and ninth month. The“state-sharing” mother who is attuned to her child promotesthe child’s developing theory of mind (or understanding ofothers’ mind states), by creating connectedness, and by thechild feeling understood. Sawyer (2007) pointed to thepotential role of mindfulness for depressed mothers in orderto promote mental presence, both with the child’s as well asher own needs. Also, in other mental disorders in whichrepetitive, preoccupied thinking plays a central role, such asanxiety disorders and eating disorders, Mindfulness trainingmay improve parental emotional presence.

Parental preoccupation with ruminative negative thinkingmay not only reduce attention for the child and affectsynchrony in interaction, it may also affect the focus of theattention for the child. To illustrate, a mother who ispreoccupied by her own eating disorder or her own obses-sive–compulsive focus on neatness may, while observing herchild eating a first spoon of food, be preoccupied by the childspilling the food or eating in an uncontrolled way rather thannoticing the child’s experimenting with all the aspects of eating(e.g., motor, smell, taste, texture and digestive).

Mindfulness is hypothesized to break the cycle ofrepetitive, negative thoughts, and to allow parents, ininteraction with their child, to attend to their child, rather

than to their inner ruminations. Furthermore, mindfulnesstechniques may help parents to pay attention to their childin a more open, non-judgmental way, instead of having abiased attention for negative cues in the child or a biased(negative) interpretation of the child’s behavior. Therefore,mindfulness applied to parents with mental disorders ishypothesized to improve parenting and the parent–childinteraction and to prevent intergenerational transmission ofnegative attentional biases. Consistent with this hypothesis,a recent study showed that, in a sample of 121 depressedparents with 9–15 year-old children, the parent’s level ofmindfulness mediated the relationship between parents’current depressive symptoms and poor parenting (Roland2009).

Parental preoccupation or negative attentional bias mayresult not only from the parental mental disorder, but alsofrom the child’s mental disorder. That is, if a child has ahistory of “bad” or “difficult” behavior, such as havingtantrums, lying, uncontrollable negative emotions, resultingfrom a child’s mental disorder or other child disability, theparent’s attention may become preoccupied by the expectedbad or difficult child behavior. Such attentional bias fornegative child behavior interferes with parental attention forneutral or positive child behavior. Thus, it is likely thatparents pay increasing attention to their children’s problembehavior, become more impulsive and irritable as well asless attentive to the child in general and less patient. Thesebehaviors come under the category of “parental reactivity”,which Miller-Lewis et al. (2006) found to be the singlesignificant predictor of chronic externalizing problems in 6-year-old children. Dumas (2005), in the context of familiesof disruptive children, called such vicious circles of rigidpatterns of disagreements and conflicts, which are over-learned with repeated practice, “automatized transactionalprocedures”. In addition to parental reactivity, parentalpreoccupation or lack of parental mindfulness may have anegative effect on other parenting tasks and behaviors inparents of children with difficulties. To illustrate, fathers ofchildren with intellectual disabilities who reported beingmore present-focused on a mindful parenting scale alsoreported more involvement in child-related parenting androles related to child socialization (MacDonald et al. 2009).

Diagnostic labels may also hinder non-judgmentalparental attention: for example, a diagnosis of an autism-spectrum disorder, oppositional-defiant or conduct disorder,or ADHD may shape the way parents view their child. Thediagnostic label may increase the parents’ attentional bias tosymptom behaviors which may set off a chain of negativecognitions. For example, when a child diagnosed withautism-spectrum disorder has a difficult play date, themother focuses on what the child does wrong (attentionalbias), labels it (“that’s his autism causing it”), and thenbegins to ruminate (“he’s abnormal,” “he’ll never be

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mainstreamed,” “He’ll never become independent,” “I’llnever have time for myself again,” “I am a bad motherbecause I have not managed to change his behavior,” “Ishould never have had children,” “I cannot cope with thisany longer”). The sadness and despair caused by such anegative chain of cognition may lead to dysfunctionalparenting behaviors such as anger outbursts, withdrawal, orovercontrol in order not to feel the sadness and despair.Coyne and Wilson (2004) denoted such a chain of negativecognition as cognitive fusion and mindfulness as cognitivedefusion. A parental bias for child negativity coming from achild mental disorder, such as conduct disorder (“He isbad”) may, in turn, instill a negative attentional bias in thechild (“I am bad”), thereby causing intergenerationaltransmission of negative attentional biases.

The importance of parental perception of a child’sbehavior, and subsequent parental preoccupations, is sup-ported by two lines of research. First, many studies haveshown that parents display dysfunctional parenting withtheir own child diagnosed with behavior problems, butdisplay functional parenting when coupled with a childfrom another parent similarly diagnosed with behaviorproblems (e.g., Dumas 2005). Second, the way parentsperceive the temperament of the child, more than the child’sactual temperament as assessed during objective observa-tions, is found to shape the way parents parent the child(see Bögels and Brechman-Toussaint 2006).

To conclude, parents’ preoccupied attention, resultingfrom parents’ own mental disorder or child’s mentaldisorder, may negatively affect parenting. Mindful parent-ing involves open and unbiased attention directed towardsthe child and the parent–child interaction and thereby mayimprove parenting and child development.

Parental Executive Functioning (Parental Reactivity)

The third hypothesis to consider is that mindfulnessimproves parental executive functioning (or reduces paren-tal reactivity) and thereby improves parenting. Parentalmental disorders that are known to be associated withexecutive dysfunction are adult ADHD, substance abuse,autism-spectrum disorder or conduct problems, and person-ality disorders such as borderline personality disorder. Suchdisorders are likely to be associated with more reactiveparenting. Also, parents of children with disorders that arerelated to impaired executive functioning are likely to haveimpaired executive functioning themselves because of thestrong genetic component in externalizing disorders (e.g.,Thapar et al. 1999). To illustrate, Hughes et al. (1997)found that parents of autistic spectrum children, especiallyfathers, had relatively poor planning skills and attentionflexibility. Similarly, adults with ADHD report lowermindful awareness levels than adults without ADHD,

particularly lower “acting with awareness” scores (Smalleyet al. 2009). Not only do parents of children with executivefunctioning-related mental disorders display poorer execu-tive function and mindful awareness themselves, there arealso indications that attention and impulsivity problems inparents negatively affect the effects of parent training. Thatis, Sonuga-Barke et al. (2002) found maternal ADHD to beassociated with lack of improvement of their preschoolchildren diagnosed with ADHD after a parent trainingprogram. Furthermore, Harvey et al. (2003) found thatmothers with the most inattention self-reports engaged in themost negative parent–child interactions after parent trainingfor parents of ADHD children. Fathers’ self-reported inatten-tion and impulsivity were strongly associated with lax andoverreactive parenting before and after the parent training, andfathers’ impulsivity was related to more arguing duringparent–child interactions measured before the parent training.Finally, children with impulsive or emotional symptoms mayelicit more impulsive reactions from their parents to beginwith, but parents with poorer executive function may havemore difficulty to inhibit such reactions.

In sum, given the genetic loadings of mental disorders thatare associated with executive dysfunction, the offspring ofparents with poorer executive functioning have a higher chanceto be predisposed to inattention, impulsivity, and reactivity.Chances are high that impulsive, reactive behavior of onemember of the parent–child dyad is responded to by impulsivebehavior of the other, leading to a vicious circle of negativereactivity. If impulsive parents can be taught to bring mindfulawareness into the interaction with their similarly impulsivechild, a circle of negative reactivity of both partners in theinteraction can be prevented. Mindfulness techniques teachindividuals to slow down their reactions and to be aware oftheir intention to act prior to taking action. In mindful parentingprograms, parents are taught to take a “breathing space” (i.e., toattend to their own breathing) before responding to difficultchild behaviors that may trigger impulsive reactions, thusreducing parental reactivity. Consistent with this hypothesis,mindfulness, as shown above, has been found to improveexecutive attention. Finally, meditation helps to bring morecalm in the busy or chaotic lives of parents, which mayfacilitate planning and organization.

Intergenerational Transmission of Parenting

The fourth hypothesis to be explored is that mindfulnesstraining may help to break the cycle of intergenerationalcontinuity of parenting. Parents are assumed to, in anautomatic or subconscious way, repeat dysfunctionalparenting patterns they have been exposed to as a child.While this has long been theorized by psychodynamicclinicians and theorists (Fonagy and Target 2002), there isalso compelling empirical evidence supporting the connec-

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tion between how parents experienced their own upbringingas children and how they parent their own children (seereviews by Puttallaz et al. 1998; van Ijzendoorn 1992, andthe special section introduced by Belsky et al. 2009). Inparticular, a lasting role for early parenting experiences hasbeen demonstrated (Kovan et al. 2009). Intergenerationaltransmission of abusive parenting (e.g., Egeland et al. 1988)even among parents who consciously attempt to be goodparents, further suggests a strong link between a parent’sown experienced upbringing and his/her parenting of his/her own children.

One of the ways in which parenting may be transmittedthrough generations is through cognitive schemas. Parentspossess “parenting schemas” that consist of information andexperiences that they have learned as children, when theywere parented by their own parents (Young 1994).Dysfunctional parenting schemas are activated by the emo-tions arising during parenting, and particularly in situationsthat bear emotional resemblances with past experiences inparents’ childhood (e.g., a child having a tantrum activates aschema related to aggression in the family of origin). Theseschemas may guide parenting behavior, without parents beingfully aware of it. In addition, the strong correlation betweenmother’s own attachment schema’s and their infants’ attach-ment classification suggests a transmission of attachment stylefrom mother to infant (van Ijzendoorn and Bakermans-Kranenburg 1996). Particularly when under stress, parentsmay repeat dysfunctional and even abusive parentingpatterns (Siegel and Hartzell 2004). Under stress, automatic,subconscious schemas and behaviors are activated via theamygdale without modification from higher cortical levels(LeDoux 1998).

One way of preventing intergenerational transmission ofdysfunctional parenting is through applying mindfulness toparents’ categorical memory. Wahler et al. (2008) havedeveloped a method to help parents of clinically referredchildren enhance the objective study of their past experi-ences with their own parents that are activated in currentparent–child stressful interactions. Parents’ stories abouthow they themselves were parented and about how theyexperience parenting their own child are recorded in astructured way by having them answer four questions: (1)“Why did you bring your child to our clinic?”; (2) “What’sit like to live with your child?”; (3) “When your child wasyounger, what do you remember about being a parent?”;and (4) “Tell me about what you can remember about lifewith your parents?”(Wahler et al. 2008, p. 226). Mindful-ness techniques are used to help parents restructure thesepresent and past parenting.

To conclude, mindfulness and particularly being mindfulduring and about emotionally intense, stressful, or painfulparent–child interactions may prevent and stop intergener-ational transmission of dysfunctional upbringing patterns.

Self-Nourishing Attention

The fifth hypothesis is that mindfulness, through promotingself-nourishing attention or self-compassion, improvesparenting. Becoming a parent involves a shift of attentionand resources from the self towards one’s child, therebyreducing self-nourishing attention. Taking care of oneselfwhile taking care of one’s child may be a prerequisite forgood parenting. Kabat-Zinn and Kabat-Zinn (1997) notethat when parents’ inner resources become depleted, theyhave to find effective ways to replenish them, withoutdoing so at the expense of their children.

Self-nourishing attention may be particularly importantfor parents suffering from mental disorders, as they mayhave grown up in environments lacking in positiveattention from parents. As a consequence, they may lackthe ability to provide positive attention to themselves.Parents of children with mental disorders may also havegreater difficulty providing themselves with self-nourishingattention, due to the increased demands and stresses ofraising a child with a mental disorder (e.g., Baker-Ericzenet al. 2005). In line, Brems et al. (1993) highlighted theimportance of attending to the parents’ own emotionalneeds during behavioral parent training.

Neff (2003) defined self-compassion as being composedof three main components: being kind and understandingtoward oneself in instances of hardship or perceivedinadequacy rather than being harshly self-critical; perceiv-ing one’s experiences as part of the larger humanexperience rather than seeing them as isolating; and holdingpainful thoughts and feelings in mindful awareness ratherthan over-identifying with them. Mindfulness interventionsteach participants to adopt a more accepting, non-judgemental, and compassionate stance toward themselves(Segal et al. 2002). Siegel (2009, p. 145) suggested that“Maybe mindfulness is actually a relational process whereyou become your own best friend,” as the social circuitry ofthe brain gets activated in mindfulness practice. Bydevoting time to the meditation practices, parents learn todevote positive attention to the self, and to begin toexperience self-compassion. This may bring about arestored balance between attention for the child and self-attention and may be one of the mechanisms through whichmindfulness training works for parents. Moreover, becom-ing more compassionate towards themselves may in turnhelp parents to be more accepting and compassionatetowards their children, especially when their childrenexpress negative emotions.

Loving kindness meditation is a form of mindfulnesspractice which specifically aims to increase positiveattention to the self. Within the Buddhist tradition, the goalof this meditation is to increase awareness of, andcompassion for, the suffering of others; however, the

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assumption is that self-compassion is the necessary firststep. The participant directs statements of compassion andwell-wishes toward the self, towards a loved one, towardsan emotionally neutral person, towards a difficult person,and finally towards all living beings (Salzberg 1995).Loving kindness meditation is hypothesized to increaseself-nourishing attention in several ways. First, it maycounteract negative biases by having participants deliber-ately attend to compassionate feelings towards themselves.Second, the assumption behind loving kindness meditationis that all individuals are worthy of compassion andunconditional love. Parents are taught to cultivate theintention to be compassionate and unconditionally lovingtowards themselves and others, regardless of how they feelabout themselves or others in that moment. In this way, thepractice reinforces the idea that compassion and caring forself are a given and do not have to be earned. A furtherassumption is that all individuals have the capacity to loveand can choose to direct that love towards themselves andothers. Many individuals with mental disorders experiencethemselves as lacking the ability to love or be loved.Practicing this meditation may help individuals be moreaware of their capacity for compassion for themselves andothers.

Loving kindness meditation may be particularly usefulfor parenting because it deliberately plays on the dynamicconnection between self and other schemas. The researchcited above on transmission of parenting suggest thatparents’ own schemas about attachment and being parentedmay affect the way they parent their own children, as wellas how they view themselves as parents. Parents withmental disorders or with children with mental disordersmay experience feelings of guilt and inadequacy about theirparenting. Due to their negative bias discussed above, theymay focus on negative interactions with their children, inwhich they feel angry or frustrated with their children, andguilty or incompetent as parents. Deliberately bringingattention to loving feelings towards their children can havea powerful emotional effect, helping parents to re-connectwith their positive feelings towards their child and viewthemselves more positively as parents. However, thesehypotheses have yet to be tested in research.

Marital Functioning and Co-parenting

Mindfulness training may affect parenting by improvingmarital functioning. There is strong evidence linkingmarital functioning with parenting and child outcomes.For example, marital quality is associated with the qualityof parenting and the parent–child relationship (Erel andBurman 1995) and is negatively associated with childbehavior problems (Reid and Crisafulli 1990). Furthermore,interparental conflict has been associated with a wide

variety of negative physiological, behavioral, and emotionaleffects on children (Cummings 1994). Mindfulness trainingmay act on three dimensions of marital functioning: maritalconflict, marital satisfaction, and co-parenting, which willbe discussed below.

Marital Conflict

Mindful parenting interventions are hypothesized to helpreduce interparental conflict by lowering partners’ emo-tional reactivity to each other, thereby preventing couplesfrom a negative spiral of anger and blame duringdiscussions of conflict. Several of the basic mindfulnesstechniques are hypothesized to reduce emotional reactiv-ity: mindful listening (i.e., listening attentively in a non-reactive and non-judgemental way); acknowledging andlabeling emotional states in a non-personal way, in orderto avoid being swept up in a negative emotional cycle(“there is anger”); noting feelings as passing mentalevents; viewing partner’s angry statements as “justwords” rather than facts; and having the intention to actcompassionately towards one’s partner, even while angry.All of these techniques aim to reduce automatic, reactiveresponding to emotional stressful interactions, withoutwithdrawing from the partner emotionally or physically.For example, Thich Nhat Hanh (2001) described severalmindfulness-based techniques to help partners deal withanger towards each other. Partners are taught first torecognize, acknowledge, and accept their own feelings ofanger, and they are taught to communicate anger to theirpartner in a planned, calm, non-reactive, and compassion-ate way, for example by scheduling an appointment todiscuss conflictual issues or by writing a letter. Whilethese communication strategies which prevent impulsivereactive responding are not specific to mindfulness, themindfulness techniques may enable partners to rememberto slow down and respond less reactively, even whenemotionally triggered. Since conflict discussions ofteninvolve emotional reactions, the mindfulness practice mayhelp couples apply what they have learned in therapy toactual conflict situations when they are emotionallyaroused.

There is some preliminary support for these hypothe-sized mechanisms. Wachs and Cordova (2007) found thatthe association between mindfulness and perceived maritalquality was fully mediated by skilled emotion repertoires,specifically those associated with identifying and commu-nicating emotions, as well as the regulation of angerexpression. Similarly, trait mindfulness was associated withgreater capacity to respond constructively to relationshipstress, lower emotional stress responses to relationshipdifficulties, and reduced marital conflict from pre- to post-therapy. In addition, state mindfulness was related to better

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communication quality during discussions (Barnes et al.2007). One practical question is whether it is more effectiveif both partners are trained in mindfulness techniquescompared with just one; but, thus far, this has not beenaddressed in any studies.

Marital Satisfaction

Mindfulness techniques may help foster more positive andsatisfying marital relationships by increasing couples’ open-mindedness and flexibility and reducing criticism andrigidity. In support of this idea, people who ratedthemselves as high on mindfulness were also high onmarital satisfaction (Burpee and Lange 2005). Furthermore,Carson et al. (2004) found that the relationship of relativelyhappy nondistressed couples improved after following amindfulness-based relationship enhancement intervention.In addition, greater mindfulness practice on a given daywas correlated with improved couple relationship function-ing in consecutive days. Further studies are needed toelucidate the exact mechanisms underlying the improvedmarital relationship, and it is not yet clear whether theseresults would generalize to families in which one spouse ora child is suffering from a mental disorder.

Finally, mindful attention to pleasurable activities, atechnique used in MBCT, can also be used to increasemarital satisfaction. Deliberately pay attention to pleasur-able events in the couples’ relationship may help couplesbecome more aware of pleasant feelings for each other, aswell as reduce the bias towards remembering negativeinteractions.

Co-parenting

Co-parenting refers to the ability of parents to support andnot disqualify the partner in the presence of the child,whether the partner is present or not (McHale 1994). Infamilies who are referred to mental health care, maritaldysfunction and unresolved divorce and postdivorce co-parenting issues are likely to be over-represented. Disqual-ification of the ex-partner is particularly relevant fordivorced couples, who may not often directly interact inthe presence of the child but who can send disqualifying orsupporting messages about the other parent to the child.Post-separation parents have been found to interact withtheir children with less affection and involvement and withgreater punitiveness and irritability (Hetherington et al.1982; Wallerstein and Kelly 1980). Furthermore, singlemothers perceived themselves as more stressed and wereobserved to display more critical and controlling parentingbehaviors than either maritally distressed or supportedmothers (Webster-Stratton 1990). These findings suggestthat postdivorce parents and single mothers may be at

highest risk of experiencing parenting stress and dysfunc-tional parenting. Supportive co-parenting may be lowest inthese groups, because of postdivorce disqualifying co-parenting or lack of co-parenting due to uninvolvement ofthe other parent. Teaching mindfulness to postdivorce andsingle parents may improve supportive co-parenting even inthe absence of the other parent. Conflicts with the ex-partner may be better resolved, and postdivorce parentsmay be better able to acknowledge their need to besupported as a parent and to share the sometimes difficultparenting task with their ex, and with others. One of theinteresting process questions for maritally distressed parentswho are still together is whether co-parenting will improvesimply as a result of improvements in marital satisfactionand conflict resolution skills, or if this area needs to bespecifically targeted.

Mindfulness Targeting Parents

Several mindfulness programs have targeted parents spe-cifically, with the assumption that, if the parent becomesmore mindful in general, this will improve parenting skillsand the parent–child relationship. The specific goals ofmindful parenting programs are to facilitate parents to bringnon-judgemental, here-and-now attention, and intentionali-ty in parenting. We will review the programs that have beendeveloped in the context of mental health problems, andtheir results, with a particular focus on the six pathways ofchange discussed above.

Altmaier and Maloney (2007) developed a mindfulparenting program to sustain emotional and physicalconnectedness between parents and children at a time ofthe parents’ divorce. Although parents were from acommunity sample and the study was not conducted in amental health care setting, divorce is a period in whichparenting stress is high, more dysfunctional parenting islikely to be displayed by both parents, and the parent–childrelationship may suffer, as was outlined earlier. Therefore,we included the study in this review. The participants were12 parent–child dyads, where the children were 33–72 months old at the time of the intervention. The programconsisted of six sessions of 2.5 h of mindful parenting in12 weeks, delivered in two small groups The programassists parents with identifying interactions that lead todisconnectedness with their children (e.g., criticizing,projecting anger, humiliating, and emotionally withdraw-ing) and replacing those interactions with intentionalconnectedness-focused interactions (e.g., listening, display-ing affection, responding calmly, and modeling self-soothing behaviors). Parents are made familiar withmindfulness practices, including breathing, body aware-ness, centering, and meditation. The idea was that, as

114 Mindfulness (2010) 1:107–120

parents become more mindful, they become more aware ofhow their responses influence their interactions with theirchild and learn to be more intentional in their parenting tochoose ways that enhance and sustain a positive emotionalconnection. The parents’ level of self-reported mindfulness(as measured through the Toronto Mindfulness Scale)increased significantly as a result of the intervention.However, parent–child connectedness, as measured bybehavioral home observations, did not increase from pre-to post-assessment. Also, in contrast to expectations,parental stress, as measured by the Parental Stress Index,was not reduced by the intervention.

Taken together, this study does not support the efficacyof mindful parenting in recently divorced parents onparental stress and the parent–child relationship. Parents’evaluations, however, showed that they considered theprogram overall helpful and thought that it positivelyaffected their relationship with their child. A possibleexplanation for the lack of effectiveness is that the programwas relatively short and participants reported difficultiesapplying and integrating homework practice. As thedivorced parents can be assumed to be under high levelsof stress, they may have needed more intense in-session andhomework practice to be able to reduce their parentingstress. A second, related, explanation concerns the timing ofthe intervention: perhaps mindfulness is more effective whengiven before a divorce, or longer after the divorce has takenplace, so that parents have more space to work with themindfulness practice offered. A third explanation concernsthe form of the training that focused on mindfulness skills ingeneral, rather than on the application to parenting.

Another study that applied mindfulness targeted toparents was conducted by Singh et al. (2007). Theyintroduced a mindfulness parenting program to fourmothers of children with developmental disabilities. Thetraining was done individually and involved meditationmethods and exercises through which the mothers couldpractice mindfulness. An important modification was thatwith the introduction of each practice, its application tomother–child interactions was also discussed. This makesthe mindfulness in the Singh et al. (2007) study more child-and parenting-oriented than that applied by Altmaier andMaloney (2007). After the 12-week-long program, themothers were asked to practice the skills they had obtainedfor 52 weeks. The results showed that the children’saggressive behavior decreased during the course andespecially over the following year-long practice phase, asdid the number of negative mother–child interactionsobserved. Observed positive interactions, on the otherhand, significantly increased. Furthermore, mothers’ self-ratings of parental satisfaction increased over time. Similarresults, using similar individual single-subject designs,were obtained in three mothers of autistic children (Singh

et al. 2006) and in two mothers of children with ADHD(Singh et al. 2010). These three studies offer support for amindful parenting program in a clinical context in whichmindfulness is thought together with its application toparenting a child with a developmental disability or mentaldisorder that is a particular challenge to parenting and theparent–child relationship and that is likely to enhanceparenting stress. Note, however, that numbers are verysmall. The studies do not provide further information as towhether the mindful parenting program affected one of thesix mechanisms described, aside from the finding thatmindful parenting changed (difficult) child behaviors thatare associated with the developmental disability or mentaldisorder of the child, such as non-compliance.

A mindful parenting course that parents follow alongsidewith their children has been described and evaluated byBögels et al. (2008). Parents of clinically referred adoles-cents (n=14, aged 11–18 years) who suffered fromexternalizing disorders (ADHD, oppositional-defiant orconduct disorder, and/or autism-spectrum disorder) fol-lowed an 8-week, one-group session a week of 1.5-h mindful parenting course, while their children followeda parallel mindfulness course for themselves (in a separategroup also eight sessions of 1.5 h). The majority (79%) ofparents participating suffered from a mental disorderthemselves: posttraumatic stress disorder, depression,ADHD, and autistic spectrum disorder. Parents wereexplained that their participation was needed for threereasons: (1) generalization of skills (homework monitoring,sharing of practice experiences, and role modeling), (2) tohelp bring calm in their families, as children withexternalizing disorders enhance parenting and family stress,and (3) parents may have similar attention or impulsivityproblems because of genetic similarities, and they mightfind the skills useful for their own life. Note that parentswere told that their participation in the mindful parentingcourse was necessary for the adolescent to be enrolled inthe child mindfulness group. Significant and substantialimprovements of the combined mindful parenting and childmindfulness training were found on adolescents’ personalgoals (child and parent report), externalizing and internal-izing symptoms (child and parent report), child self-control(parent report), attention (child performance and childreport), and child social behavior (parent report). Effectsizes of change ranged from medium to very large.Moreover, parents reported large improvement on theirown goals concerning their parenting and the parent–childrelationship. Despite these promising results in a referredclinical group, it remains unclear whether these positiveeffects result from the adolescent mindfulness training, themindful parenting training, or the combination of both.

Next, we piloted mindful parenting in a group of tenparents only (n=8 mothers of whom three were divorced,

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and one parent couple) of children of mixed ages (5–14 years) with mixed psychopathology: AD(H)D, ODD,PDD, anxiety disorders, and V-code parent–child problem(Bögels et al., in progress). Children were not involved inthe course. Taking into account the heterogeneity of thegroup, the mindful parenting program was primarilyfocused on parenting in general and not on parenting achild with particular difficulties. The program consisted ofan 8-week one-session a week, 3-h group meeting, andrequired serious homework commitment of at least 1 h ofmeditation practice a day. Each session consisted of about2 h of regular MBCT/MBSR training (body scan, sittingwith the breath, breathing space, seeing and hearingmeditation, mindful walking, and yoga). Roughly 1 h ofeach session focused on (1) understanding the role ofparental reactivity (“the low road”, Siegel and Hartzell2004) and its relatedness to stress and fatigue, ownupbringing patterns, personal or relational difficulties (e.g.,lack of perceived partner support), child mental healthproblems (e.g., behavior problems), and historically grownparent–child interaction patterns, (2) taking care of yourself asa parent, (3) non-judgmental attention for the child, (4)acceptance of the child and its difficulties, and (5) ruptureand repair in the context of parenting. Roughly two third of thehomework focused on regular MBSR/MBCT formal andinformal meditation practice, and one third concernedhomework practice bringing mindfulness into parenting. Allparents except one completed the program, and session andhomework compliance was excellent.

All parents except one completed a series of question-naires before and after the program, measuring parentalstress, parental rearing style, marital satisfaction, and co-parenting. Results indicate that the program stronglyreduced parental rejection of the child and had positiveeffects on autonomy encouraging parental rearing style, onreducing parental overcontrol, on increasing affection andtogetherness in co-parenting and decreasing disagreementsin co-parenting, on reducing parental stress, and onincreasing marital satisfaction for those who were married.Results provide some preliminary support for two of the sixproposed pathways of change by mindful parenting in amental health care context: reducing parental stress and theassumed effect on parental reactivity and improving maritalfunctioning and co-parenting. The design and small powerof this pilot study prohibits further analysis of mediation ofchange mechanisms, but one direction of research would beto investigate whether reduction of parental stress is themechanism through which parental reactivity towards thechild is reduced. In addition, as meditation directly affectsattention processes such as disengaging from negativestimuli (Ortner et al. 2007), the reduced parental rejectionof the child might be a direct consequence of mindfulnesspractice. Furthermore, the reduced parental rejection is

consistent with the finding that meditation improvesexecutive attention (Jha et al. 2007).

Vieten and Astin (2008) considered the negative effectsthat prenatal stress and low mood can have on the mother–infant attachment relationship and child development, in asmall randomized control trial (n=31). With this in mind,they developed a mindfulness-based intervention program(“Mindful Motherhood”) for to-be mothers, with the goal ofimproving mothers’ mood and reducing stress in pregnancy.The program cultivated mindfulness of feelings, thoughts,and body, through breath awareness, body awarenessmeditation, and mindful hatha yoga. In addition, acceptanceand observation of self were incorporated. The resultsshowed that mothers-to-be who had participated in themindfulness program had significantly lower state anxietyand better mood than waitlist controls. These differencesdid not hold in a 3-month follow-up, though, and there wasno follow-up of whether the program had any effect oninfant development. However, this was just a small-scalepilot study and certainly justifies further research toinvestigate the potential of the program. Similar studieson mothers-to-be with mental disorders still need to beconducted.

There is also preliminary work in the context ofintergenerational transmission of disorder that targets theparent–infant relationship. We are in the final stages of aproject that investigates how a specific child-orientedmindfulness intervention, aimed at mothers who sufferfrom postnatal depression or anxiety disorders, affectsmother–child interaction (Stein et al., in progress). Thegoal of the project was to investigate whether the present-oriented, purposeful attention that mindfulness cultivateswould decrease the mothers’ negative, preoccupied think-ing, and therefore allow the mothers to redirect theirattention to their children. Piloting demonstrated thatbecause of the often hectic nature of life with youngchildren, asking postnatal mothers to commit to the amountof time that a typical mindfulness course involves would betoo much. Therefore, we developed a 5-min long medita-tion practice that we asked the mothers to do at home everyday for 2 weeks before they visited us in our laboratories.

The participants were randomized to either the mindful-ness or the control intervention. The laboratory visit startedby the mothers playing with their child, so as to obtain abaseline measure of their interaction. Next, we primed themother to become preoccupied (by asking them to thinkabout their worries) and then gave them either a mindful-ness or a control intervention. Both were 10 min long andwere presented through headphones, while a researcherplayed with the child to keep him/her occupied. Afterwards,the mother and child were asked to play together again, sothat we could compare the mother–child interaction afterthe intervention. The control intervention just asked the

116 Mindfulness (2010) 1:107–120

mothers to think about their own thoughts. The mindfulnessintervention started with a short breathing meditation,which was familiar from the home practice. The rest ofthe intervention was a mindful meditation focussing on thechild, whom the mother could see while listening. Therecording asked the mother to pay attention to the texture ofthe child’s hair, the color of their clothes, and so on, as ifthey saw the child for the very first time. Participants’ self-reports have indicated that, on the whole, they found theintervention pleasant, and many have stated that it has beenhelpful. The results of the effect of the intervention onmother–child interaction are still pending and will allow usto evaluate the effect of the intervention on a moreobjective measure.

Also, mindful parenting has been described in thecontext of prevention of psychopathology in early child-hood by the enhancement of mentalizing (Fonagy 1998).Reynolds (2003) described a parent–infant group approachto enhance reflective capacity in parents. Parents developan active observational stance, through the accumulatedpractice of directing quieted, patient, curious, alive attentionto both infant and self and through learning to respect andfollow the child’s lead in contact-seeking and exploration.The parent’s activity of simply slowing down enough tonotice serves an empathic function. Thus, the infant’scapacity to see, feel, venture into, experience, and eventu-ally think about the textural, dimensional properties of theirworld (hard–soft, close–far, fast–slow) is brought to theforeground of the parent’s mind for reflection. The parents,together with four to six infants that are grouped develop-mentally, with no more than 4 months’ difference in age,make an 8-week commitment after which they maycontinue for as long as they find the experience useful.The average length of stay was 6 months. Results havebeen described in case vignettes, demonstrating parents’increased tolerance for insecurity (process 1: stress), as wellas their ability to wait (process 3: executive functioning).No quantitative results were provided.

Finally, in the context of adolescent drug prevention,Duncan et al. (2009) added mindful parenting to a behaviorintervention called Strengthening Families Program, forparents of early adolescents. Five core aspects of mindfulparenting were added: (1) listening with full attention, (2)maintaining emotional awareness of oneself and one’s childduring parenting interactions, (3) practicing non-judgmentalopenness and receptivity when children share their thoughtsand feelings, (4) regulating one’s own automatic reactivityto child behaviors, and (5) adopting compassion to oneselfas a parent and toward the struggles one’s child faces. Fivenormal community families (four couples, one singlemother) of five sixth-grade girls (average age, 11.5 years)participated in a 2-h program for 7 weeks. Qualitativeevaluation took place in the form of a focus group. Parents

reported greater awareness of how their moods affect how theyreact and less reactivity towards their children (process 1).

To conclude, several mindful parenting programs havebeen developed in the mental health or prevention context,either as a stand-alone treatment or in combination withbehavior interventions. Most programs focused on parents ofchildren with mental disorders, some on parents with mentaldisorders, and some on at-risk parents. There is preliminaryevidence that mindful parenting programs reduce parentalstress and resulting parental reactivity (process 1), reduceaspects of child mental disorder (process 2), and improvemarital functioning and co-parenting (process 6). Research,however, is limited to evaluation of pilot studies withoutcontrol groups other than waitlist control.

Discussion

Mindfulness is an increasingly widely used intervention fordifferent psychological and physiological problems andillnesses. In recent years, there has also been somemindfulness work that has specifically targeted parents.Quite a number of studies suggest that attention is one ofthe cognitive mechanisms that is affected by mindfulnessand that potentially plays a role in the different processesaddressed by mindfulness for parents in clinical settings: (1)reducing parental stress; (2) reducing parental preoccupa-tion resulting from parental and/or child psychopathology;(3) improving parental executive functioning in impulsiveparents; (4) breaking the cycle of repeating dysfunctionalown upbringing schemes and habits; (5) increasing self-nourishing attention; and (6) improving marital functioningand co-parenting.

The results of the studies targeting primarily parents andtheir parenting skills are, in principle, hopeful, particularlythose that demonstrated changes in child symptomaticbehavior, especially since mindful parenting does notspecifically target problematic child behavior. However, itis important to keep in mind that the children of the parentsin the studies had different diagnoses, varied in age, andneither study had a control group. In general, on the basisof the current small-scale studies, it is difficult to point outwhat the observed effects were due to. Therefore, it wouldbe very important to conduct larger-scale, controlled studiesthat would have power to detect effects of treatment as wellas address mediation mechanisms.

In future, it would be important to systematicallyinvestigate the effectiveness of mindfulness programs fordifferent participant groups (with respect to child problemsas well as parental problems) as well as testing specifichypotheses about the six mechanisms through which theprogram might work in clinical settings. This is crucial ifwe are to achieve a more comprehensive understanding of

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how and when to apply mindful parenting for parentingissues. This would enable us to make more precisepredictions as to which target groups of parents and theirchildren might benefit from mindful parenting and how tobest tailor them to suit participants’ needs.

Mindfulness may not be the most appropriate approachto all disorders, and although the currently availableexperiments strongly suggest that attention is implicated,this is still a very vague principle to apply when decidingon treatment approaches. Furthermore, since mindfulnessdoes need to be adapted to suit busy parents’ schedules, itwould be waste of resources to use mindful parenting withgroups that are unlikely to benefit from the treatment orwith groups that benefit strongly from existing parenttraining programs. One example of a group of parents thatmight particularly benefit from mindful parenting is parentsof children with externalizing disorders such as ADHD,who themselves suffer from attention and/or impulsivityproblems. These parents are found not to benefit (enough)from behavior parent training programs.

Next steps in mindful parenting research thus includedesigning studies with larger participant numbers andcontrol groups, and eventually running randomized con-trolled trials, for example, comparing mindful parenting tobehavioral parent training. It is also necessary to investigatewhether interventions affect the specific cognitive skills andaspects of behavior that mindfulness would be expected totarget, such as different attentional skills. The hypothesiscould be tested whether mindful parenting works primarilythrough changing attentional processes in parents, whereasbehavioral parent training works primarily through chang-ing parental behaviors. Also, it would be interesting toexamine whether adding mindful parenting to behavioralparent training enhances the effect of the latter and whatwould be the best order of interventions: starting withmindful parenting, followed by behavioral parent training,starting with behavioral parent training, followed bymindful parenting, or combining both approaches in oneparenting program. Finally, it is important to investigatewhether the application of mindfulness to parenting is at allneeded to achieve the kind of effects that mindful parentingappears to have or that the standard 8-week MBCT orMBSR program in mental health settings has similar effectson parents.

These are just a few questions that are pertinent at thispoint in time, when interest in mindfulness for parentingissues and children’s psychological problems is increasingand we have some, but not enough, evidence thatmindfulness might be an effective approach for thesegroups. The challenge now is to work out in more detailwhere the benefits lie and how to best tailor mindfulness-based parent programs so that they suit this specificparticipant group both in the practical and theoretical terms.

Open Access This article is distributed under the terms of the CreativeCommons Attribution Noncommercial License which permits anynoncommercial use, distribution, and reproduction in any medium,provided the original author(s) and source are credited.

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